Incidental discovery of multiple myeloma, presenting as an amyloid tumor with plasmacytic elements of the thoracic wall

Open access

Abstract

Multiple myeloma is characterized by monoclonal proliferation of bone marrow plasma cells causing multiple bone lesions and overproduction of a monoclonal protein (M-protein) that could deposit in tissues (amyloidosis). Dissemination of the multiple myeloma outside the bone is rare.

We present a case of a 76 years old woman presenting with dry cough. Chest X-ray showed a giant tumor of the upper right lung. Contrast enhanced CT revealed a tumor that most probably originated from the structures of the thoracic wall. The transthoracic biopsy was inconclusive. The tumor was resected and the histopathological examination showed amyloid tumor of the thoracic wall with plasmacytic elements and lambda light chains deposits. A bone marrow aspiration was performed that found diffuse plasmacytic infiltrate of 20-60% and the serum proteins electrophoresis with immunofixation revealed elevated IgA and lambda light chains. The patient was diagnosed with IgA and lambda light chains multiple myeloma with consequent AL amyloidosis presenting as thoracic mass.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. PALUMBO A ANDERSON K. Multiple Myeloma. N Eng J Med. 2011; 364(11):1046-60.

  • 2. HOWLADER N NOONE AM KRAPCHO M GARSHELL J MILLER D ALTEKRUSE SF et al. (eds) SEER Cancer Statistics Review 1975-2011 National Cancer Institute Bethesda MD http://seercancergov/csr/1975_2011/ based on November 2013 SEER data submission posted to the SEER web site April 2014.

  • 3. KING AJ GOODING S RAMASAMY K. Managing multiple myeloma in the over 70s: A review. Maturitas. 2015; 80(2):148-54.

  • 4. RAJKUMAR SV DIMOPOULOS MA PALUMBO A BLADE J MERLINI G MATEOS MV et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014; 15(12):e538-48.

  • 5. HUGHES M SOUTAR R LUCRAFT H OWEN R BIRD J. Guidelines on the diagnosis and management of solitary plasmacytoma of bone extramedullary plasmacytoma and multiple solitary plasmacytomas: 2009 update 2009. Available from: http://www.bcshguidelines.com/documents/solitary_plamacytoma_bcsh_FINAL_190109.pdf.

  • 6. SOUTAR R LUCRAFT H JACKSON G REECE A BIRD J LOW E et al. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Br J Haematol. 2004; 124(6):717-26.

  • 7. KILCIKSIZ S KARAKOYUN-CELIK O AGAOGLU FY HAYDAROGLU A. A review for solitary plasmacytoma of bone and extramedullary plasmacytoma. Scientific World Journal. 2012; 2012:895765.

  • 8. INTERNATIONAL MYELOMA WORKING GROUP. Criteria for the classification of monoclonal gammopathies multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003; 121(5):749-57.

  • 9. GILLMORE JD WECHALEKAR A BIRD J CAVENAGH J HAWKINS S KAZMI M et al. Guidelines on the diagnosis and investigation of AL amyloidosis. Br J Haematol. 2015; 168(2):207-18.

  • 10. BIRD JM OWEN RG D'SA S SNOWDEN JA PRATT G ASHCROFT J et al. Guidelines for the diagnosis and management of multiple myeloma 2011. Br J Haematol. 2011; 154(1):32-75.

Search
Journal information
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 286 150 2
PDF Downloads 153 96 4